The Importance of Bile In Thyroid Health

October 2, 2014

Bile is a fluid that is produced by the liver, and stored and concentrated in the gallbladder. It plays a role in digestion, specifically helping to break down fats into fatty acids. Many people have thick and sluggish bile, which commonly results in gallbladder surgery. But of course the surgery isn’t doing anything for the actual cause of the thick and sluggish bile. When you think about it, there is a lot in common with both gallbladder surgeries and thyroidectomies, as there are hundreds of thousands of these surgeries performed each year, and many of these could be avoided by addressing the actual cause of the condition.

There are approximately 500,000 gallbladder surgeries performed each year. But when someone has a problem such as gallstones, the problem usually isn’t with the gallbladder itself. If this is the case, then why is the gallbladder frequently removed when someone experiences recurrent cases of gallstones? Of course the main reason is because most medical doctors don’t know what else to do. To be fair, although many gallbladder problems can be prevented, sometimes the person reaches the point where gallbladder surgery might be necessary. While many times changing one’s diet or doing other things can help to prevent surgery, sometimes surgery is unavoidable.

Why Do Many People Have Gallbladder Problems?

Before I discuss some of the reasons why many people have gallbladder problems, I’d like to expand on the importance of bile. As you already know, bile helps to break down fats into fatty acids. Because of this, if someone has problems with bile, they will have problems breaking down fat soluble vitamins such as vitamins A, E, K, and D. They also might have problems digesting fish oil supplements, as well as other types of fats, such as the healthy fats present in avocados. Hopefully you are beginning to understand how problems with bile production can lead to nutrient deficiencies. And since removing the gallbladder won’t correct the bile problem, these people will still have problems breaking down fat soluble vitamins from the foods they eat.

In moderate to severe cases the person might experience certain symptoms when eating fatty foods, and thus might avoid not only greasy foods, but healthy fats such as nuts, seeds, and avocados. However, just because you’re not experiencing symptoms when eating these foods doesn’t mean that you aren’t having any problems with bile production. In fact, some people with mild to moderate bile production problems will have no symptoms. On the other hand, some of the common symptoms of gallbladder problems include bloating, gas, nausea, fatty stools, pain between the shoulder blades, and abdominal pain.

In addition to helping to break down fats, bile also plays an important role in the excretion of waste products. What happens is that the liver metabolizes toxins, and bile excretes them. This not only includes numerous environmental toxins, such as heavy metals, but also drug metabolites, and even the steroid hormones. This is how problems with bile relates to estrogen dominance, as if someone has estrogen dominance due to the buildup of bioidentical estradiol and/or xenoestrogens in the tissues, then this will lead to bile that is thick and sluggish. However, it’s not just estradiol which can change the properties of bile, as there is evidence that estriol, which is the main estrogen in pregnancy, produces profound changes in bile salt dependent flow and can lead to increased gallstone formation (1).

The Components of Bile

There are three main components of bile, and this includes 1) bilirubin, 2) bile acids and salts, and 3) cholesterol. Most people reading this are familiar with cholesterol, but you might not be familiar with the other two main components of bile. Bilirubin is the toxic catabolic product of heme metabolism, and the goal of bile is to help with the excretion of bilirubin. However, certain factors can cause a disturbance of bilirubin transport, which causes increased levels of bilirubin in the blood (hyperbilirubinemia), which in turn can lead to jaundice if the levels become high enough. Gallstones are a common reason for cholestasis, which is when there is a disruption of the flow of bile from the liver to the small intestine, although there can be other factors involved as well.

I’ve already mentioned some of the benefits of the bile acids/bile salts already, but they have numerous other functions as well. In fact, the bile salts play a big role in inhibiting the growth of bacteria in the small intestine (2). As a result, if someone has problems with the production of bile, then this can increase the risk of developing a condition such as small intestinal bacterial overgrowth (SIBO). Because of this it would make sense to give bile salts to those who currently have SIBO. This isn’t to suggest that the primary cause of SIBO has to do with low bile acids. Other factors can cause SIBO such as low or absent production of gastric acid, a deficiency of the pancreatic digestive enzymes, problems with the immune system, motility disorders, and other health issues. In addition to preventing the growth of bacteria in the small intestine, bile also might have antimicrobial properties against H. Pylori. Although bile acids are conjugated with taurine or glycine in the liver to form bile salts, there is some evidence that unconjugated dihydroxy bile acids has antibacterial activity against H. Pylori (3).

There is also evidence that bile acids play a role in preventing insulin resistance, as they appear to be signaling molecules that play important roles in glucose and lipid metabolism (4)(5). I of course mentioned earlier how bile is important for breaking down fats into fatty acids. It’s actually the bile receptors FXR and TGR5 which help to regulate lipid and carbohydrate metabolism, as well as inflammatory responses (6)(7). However, it’s the bile acids which activate these receptors. So having proper bile production can play a role in preventing insulin resistance and conditions such as non-alcoholic fatty liver disease.

Why Do Gallstones Form?

Because so many people develop gallstones, it probably is a good idea to discuss why gallstones form. Could it possibly be related to problems with bile production? It might be best to begin with a brief anatomy lesson, as I mentioned earlier that it’s the liver that produces bile, and the gallbladder stores and concentrates it. Your gallbladder will then release bile through a tube called the common bile duct. This duct connects your gallbladder and liver to the small intestine. Gallstones form when substances in bile harden, and this gallstone can block the flow of bile through the bile ducts, and this usually results in symptoms such as nausea, pain in the mid-back or abdomen, and sometimes vomiting.

There are two main types of gallstones. Gallstones made from cholesterol are the most common type, and are not related to cholesterol levels in the blood (8). One can also have gallstones made from bilirubin, which occur when red blood cells are destroyed and too much bilirubin is in the bile (8). Most medical doctors don’t think the formation of gallstones can be prevented, and while this might be the case in some situations, this isn’t true for the majority of gallbladder problems involving gallstones.

Diet of course is one of the main causes, as there is evidence that dietary factors can increase the risk of developing cholesterol gallstones. Dietary factors that may increase risk include cholesterol, saturated fat, trans fatty acids, refined sugar, and possibly legumes (9). Gallstones are also common in obesity (10)(11). Another study suggested that dietary constituents are important determinants for the formation of lithogenic bile (12). This doesn’t mean that eating a healthy diet will completely eliminate the risk of developing gallstones, but I think it’s safe to say that eating well will greatly reduce the likelihood of developing gallstones.

However, there are other factors to consider as well. For example, since estrogen dominance can make bile thick and sluggish and thus lead to the formation of gallstones, it shouldn’t be a surprise that there is evidence that those who take oral contraceptives are at an increased risk for gallbladder disease (13)(14). And while there are currently no studies which show a correlation between xenoestrogens and gallstones, there is no question that xenoestrogens can cause estrogen dominance, and since high levels of estrogen will affect bile production I think it’s just a matter of time before we see some clinical trials showing a correlation between the two.

What Are The Benefits and Risks of Gallbladder Surgery?

The obvious benefits of gallbladder surgery is that it will help to resolve the symptoms associated with the gallstones. However, as I mentioned earlier, surgically removing the gallbladder doesn’t do anything for the actual cause of the problem. And although most gallbladder surgeries are successful, there still are potential risks, such as injury to the common bile duct, injury to the small intestine, an infection, or internal bleeding. In addition, 5% to 40% of people who have the gallbladder removed may experience symptoms of postcholecystectomy syndrome which can include upset stomach, nausea, vomiting, gas, bloating, diarrhea, and persistent pain in the upper right abdomen (15).

But the main problem with gallbladder surgery isn’t the potential risks of the surgery, nor is it the symptoms associated with postcholecystectomy. The main issue is that removing the gallbladder won’t correct the bile problem. So if you have a condition such as estrogen dominance which caused problems with bile production and resulted in gallstones, removing the gallbladder obviously won’t correct the estrogen dominance problem. Similarly, if you are not efficiently breaking down fats into fatty acids, then getting gallbladder surgery isn’t going to help with this either.

What Role Does Bile Play In Thyroid Health?

So how does bile relate to thyroid health? First of all, thyroid hormones alter bile acid metabolism in humans (16)(17). In addition, a small study showed that bile acids play a role in human energy metabolism and in thyroid hormone control (18). However, larger studies are needed to confirm this. As for how hypothyroidism and hyperthyroidism affect bile, one smaller study showed that hypothyroidism may result in delayed emptying of the biliary tract (19). The same study suggested that this might be the cause for the increased prevalence of common bile duct stone formation in hypothyroidism. With regards to hyperthyroidism and Graves’ Disease, bile acid malabsorption can be associated with some people who have hyperthyroid conditions (20).

There are also indirect relationships between bile production and thyroid health. For example, earlier I discussed how problems with bile production can lead to deficiencies in the fat soluble vitamins. And both vitamin A and vitamin D play an indirect role in thyroid health. Not too long ago I wrote an article entitled “Can a Vitamin D deficiency Cause an Autoimmune Thyroid Condition?” I discussed how a vitamin D deficiency can make someone more susceptible to developing an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis. Vitamin A is also important for the health of the immune system, but it’s also important for the health of the gut, as a deficiency of vitamin A might be a factor in the development of a leaky gut (21).

How To Have Healthy Bile Production

So what can someone do to improve the health of their bile? Obviously eating well is important, as you want to avoid refined foods and trans fats. Numerous studies also have shown that taking vitamin C supplements can help to prevent the formation of gallstones (22)(23)(24), and so this is also something to consider. Eating beets or taking supplements which contain beets can help, and choline can also be beneficial. Certain herbs which can help improve biliary function include dandelion root, fringe tree, and globe artichoke.

In the textbook “Nutritional Medicine” by Dr. Alan Gaby, he discusses the impact of food allergies on gallbladder health, and how the gallbladder can be a target organ for allergic reactions. He also mentioned an uncontrolled study where identification and avoidance of allergenic foods eliminated gallbladder symptoms in 100% of patients (69 in total) with gallstones or postcholecystectomy syndrome (25). So this is yet another reason to consider avoiding common allergens such as gluten, dairy, corn, etc.

Since estrogen dominance can make bile thick and sluggish, if you have this condition you will want to address it. For example, I mentioned how oral contraceptives can lead to the formation of gallstones. And many people reading this are already aware of the impact of xenoestrogens on our health, and so minimizing your exposure to these toxins can lead to healthy bile production and a decreased incidence of gallstones.

Doing a gallbladder flush may be beneficial. Although there is controversy over whether or not these truly will result in the passing of gallstones, numerous people have been helped by doing a gallbladder flush. However, while a gallbladder flush can be beneficial, there are potential risks involved. For example, if you have a large gallstone, it can possibly block the bile duct when trying to expel it with a gallbladder flush, which can result in a medical emergency. This is rare, although still is something to keep in mind.

What Should You Do If You Don’t Have a Gallbladder?

If you have had your gallbladder surgically removed, then you still will want to follow the advice given in this post. After all, remember that removing your gallbladder didn’t do anything for the bile problem, and so even after gallbladder surgery you want to do things to help improve biliary function.

So hopefully you now have a better understanding of how important normal bile production is not only to thyroid health, but having problems in this area can affect other areas of your health as well. There are way too many gallbladder surgeries performed, and while some of them are necessary, most of these “gallbladder problems” could be prevented by eating well, along with being aware of other factors which can affect bile production, such as taking oral contraceptives. As I discussed in this post, bile is important for breaking down fats into fatty acids, plays an important role in the excretion of waste products, and bile also has antimicrobial properties. If someone is trying to prevent the formation of gallstones, or even if they already have gallstones, one will want to eat a healthy diet, avoid common food allergens, consider supplementing with vitamin C, incorporate beets and/or choline into the diet, minimize their exposure to xenoestrogens, and there are times when they might want to consider doing a gallbladder flush.

I was wondering how vit K2 and thyroid and gallbladder are related. Is it the lack of d3? Am having bad issues with k2….terrible pain!!
Tried nascent iodine and that made a mess of me, too…maybe went too fast??? Was hoping for more energy and weight loss…I had the energy…and as soon as I stopped within a few days the energy was gone.

I’m not sure exactly what your question is, as the gallbladder of course plays a role in fat metabolism, and vitamin K2 is fat soluble. And so if someone has problems with bile, then they might have a problem breaking down vitamin K, along with other fat soluble vitamins such as vitamin A, D, and E. As for the iodine, although many people are deficient in iodine, not everyone does well when taking iodine, especially if they have low antioxidants (i.e. selenium, vitamin C).

Thank you for addressing an issue that seems to receive far too little attention. Acupuncture acknowledges the important role of the liver/GB where western medicine lacks. I hope you will pursue this topic further, especially if there are 500k surgeries being performed a year. I would be curious about liver cleanses, especially for those of us w/o a GB and how to cope with the toxic effects cleanses often generate (Herxheimer effect). So if someone is w/o GB are digestive enzymes the only way to break down the needed fats?

If someone has had their gallbladder removed then they will still produce bile, but it of course won’t be stored and concentrated, which can affect the breakdown of fat. And so this is one reason why people who have had their gallbladder removed should consider taking bile salts. I’ve had patients without gallbladders do a liver detox, and while it’s common for people to experience detox symptoms such as headaches, perhaps an increase in fatigue, in most cases people don’t have a severe detox reaction. With that being said, it of course is important that one is having regular bowel movements daily, as having 2 or 3 bowel movements will help to minimize the symptoms associated with a detox. Obviously drinking plenty of water is critical when doing a detox. Sometimes taking extra N-acetylcysteine (NAC) can also help minimize the detox reactions but speeding up the clearance of toxins.

I have recently been dignosed with hyper thyroidism, I just printed your book on natural ways to control it. I am a little bit hesitant to attemt this , it apears that it takes great dedication. I am an executive chef, and I need help changing my eating habits. I have lost 32 lbs in 6 weeks, and continue to loose weight every day. And I feel like I’m dying, I am taking a beta blocker which I just started, and it makes me feel better, but even the waves of adrenalen still get threw. I have every clasic symptem, sweeting, hart rate of above 110 beats per min, anxity, etc. This is knew to me, I am not used to taking medicene, and The doctor I finaly got to see, had predetermined that I needed the raidated iodine treatment and was ready to schedule the procedure that week. I took a step back and I am seaking a second opionion from an other endocronolagist. I am so sick and desperate, I am asking you as a stranger, What can I do. Your book is a long term solution, I need imedate relief. I cant sleep, I cant eat, now This medicen makes me feel better, but I still have the problem. I just am so confused as what to do. Your thoughts?

I understand your hesitation to follow a natural treatment protocol, as you are correct in that it takes a great amount of dedication on your part. Keep in mind that the beta blocker will help with the cardiac symptoms, but it won’t decrease the elevated levels of thyroid hormone, and lowering the thyroid hormone levels can help further with the symptoms while addressing the cause of the problem. Taking antithyroid medication or an herb such as Bugleweed probably will provide additional relief, but of course these aren’t correcting the cause of the problem. Unfortunately there isn’t a short term solution to correcting this condition, as it takes time to restore one’s health.

Hi Dr Eric
I was diagnosed with a raised TSH level of 5.6 (normal 0.3-4.2) in Aug 2013 T4 of 12.7 (12-22 normal). In Nov I started taking levothyroxine 50mcg. I have been under a lot of stress, father dying, husband walked out on me 2013, 2 dependent children, 90 year old mother, money problems. In Jan 2014 I suddenly had a heart attack. They can’t find what caused it, arteries were all clear, good pumping action etc. I got palpitations, anxiety, chest pains, I was in an awful state until in March 2014 my T4 was 16.7 and TSH .27 below normal range. I was given 25mcg levothyroxine and I felt so much better. But my side effects were causing me worry as I was putting it down to my heart but noticed that the brand of levothyroxine was changed and my chest pains gradually went over a week, the pain in my legs stopped, my head pains stopped and my internal tremor ceased thank goodness. But now on Actavis and getting belching, ringing in the ears, felt faint yesterday and feel as though my heart isn’t beating as strong or maybe a lower blood pressure. I have always had a low blood pressure. I was interested in the bile information as 3 days before my heart attack I was sick and just bringing bile up, I was having awful cramps involving both legs and had bad anxiety, I was crying on the phone to my friend I was so bad. I have had sore stiff joints and tight ligaments for years now. I am 57 years old and was sporty and active but for the last few years I have been putting on weight slowly, I am losing my hair, my skin is thick, my eyes are bloodshot and my muscles have vanished giving me a curved back and just feel like an old woman. My eyesight has also deteriorated. I am on Clopidogrel and aspirin since the heart attack. Doctors don’t want to change my thyroid although my results in June were T4 12.5 and TSH 5.17 although I have heard that aspirin can affect results. I just want to manage this now naturally, I have had enough of all these drugs. Over the last few years I have had my mercury fillings removed. I was found to be very low in magnesium and zinc a few months after my heart attack but wasn’t tested for these at the time. I did smuggle CoQ10, resveratrol, and a few other heart supplements into the hospital, the cardiologist hadn’t even heard of CoQ10!! They put me on statins but I just take plant sterols instead and have a cholesterol level of 3.7 (2.8-5). My heart rate is about 55bpm. I have refused to take any other heart medication including Ramipril. I am having thoughts that my heart attack was due to low magnesium, zinc and thyroid especially as I was ill a 2 days before. Since taking magnesium the cramps have nearly gone and if I do get a cramp at night I use a magnesium spray which stops it very quickly. I have had cramps for years but it was just the worst every beforehand. Any ideas Dr Eric? The doctors here in the UK aren’t as advanced or forward thinking as the US. Please help before they start going down the drugs route. I avoid sugar now and try and eat healthy but its not improving. Regards from across the Ocean

The first thing you mentioned is that you have been under a lot of stress, and so I definitely would recommend getting a saliva adrenal panel. Also, have you had the thyroid antibodies tested? You said you had your mercury fillings removed, which is great, but did you do anything during this time to help eliminate the mercury built up in your tissues? While taking the thyroid hormone medication might be necessary, at least on a temporary basis, I would recommend finding a local natural healthcare professional who will do more than recommend levothyroxine. Although you might have bile metabolism problems, with all of the stress you’ve deal with you most likely have problems with your adrenals/HPA axis, might have a leaky gut, etc. And while it’s great that you’re eating well and are taking some supplements, the goal should be to detect and then address any imbalances which might be causing or contributing to your condition.

Hello doc!
How about my case? I’m having irreg bowel mvmts and constipation for 8 yrs now.
I already had colonoscopy and it’s normal accdg to the dr. But i really dont feel normal, im also having stomach cramps sometimes. My stool is always bad color, like dark brown, nearly black color, and green. Now, im still pooping green stool. Im always bloated and my fart is smelly. Haha
Sometimes my anus is bleeding because of hard stool or if i cant eradicate. I often have very small hard stool like that of a rabbit’s. Im also checking my diet. I had not eaten rice for 5 yrs because i feel bad when i consume it.
I also tried banana diet. But i research that bananas make me heavy, that’s why i minimized it because im easily getting tired.
I think my drinking habit is good. I dont know what to do. Please advise me what can i improve in my habits, what can i do doc?